Peritonealcarcinoses
Tumor Cell Entrapment
The 'tumor cell entrapment' hypothesis explains the inevitable progression of malignancy in patients who undergo treatment of peritoneal surface cancer using surgery alone. This theory relates the high incidence and rapid progression of peritoneal surface implantation to
- free intraperitoneal tumor emboli,
- fibrin entrapment of intra-abdominal tumor emboli on traumatized peritoneal surfaces
- blood clots that remain in the abdomen or pelvis that contain viable cancer cells
- progression of entrapped tumor cells through growth factors involved in the wound healing process.
These phenomena may cause a high incidence of surgical treatment failure in patients treated for primary gastrointestinal cancer. The reimplantation of malignant cells into peritonectomized surfaces in a reoperative setting must be expected unless perioperative intraperitoneal chemotherapy is used.
Chemotherapy employed in the perioperative period not only directly destroys tumor cells but also eliminates viable platelets, white blood cells and monocytes from the peritoneal cavity. This diminishes the promotion of tumor growth associated with the wound-healing process. Intraperitoneal chemotherapy should eliminate local recurrence and peritoneal surface recurrence. Removal of the leukocytes and monocytes also decreases the ability of the abdomen to resist an infectious process.
Chemotherapy employed in the perioperative period not only directly destroys tumor cells but also eliminates viable platelets, white blood cells and monocytes from the peritoneal cavity. This diminishes the promotion of tumor growth associated with the wound-healing process. Intraperitoneal chemotherapy should eliminate local recurrence and peritoneal surface recurrence. Removal of the leukocytes and monocytes also decreases the ability of the abdomen to resist an infectious process.